Provider Demographics
NPI:1083184279
Name:VALLE, FANNIE C
Entity Type:Individual
Prefix:
First Name:FANNIE
Middle Name:C
Last Name:VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3819
Mailing Address - Country:US
Mailing Address - Phone:954-668-0333
Mailing Address - Fax:
Practice Address - Street 1:7031 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3819
Practice Address - Country:US
Practice Address - Phone:954-668-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide